Causal and Conceptual Knowledge: Implications for Clinical Reasoning

项目概述：本提案旨在根据(1)现行DSM和(2)修订DSM的建议，了解精神卫生专业人员对精神障碍的概念。首先，DSM-IV故意没有详细说明精神障碍的原因，因为它们仍然存在争议。然而，NIMH先前的研究发现，临床医生对精神障碍有丰富的因果理论，这些理论决定了哪些症状在诊断中更重要。拟议的研究建立在这些研究的基础上，并将进一步研究是什么缓和了临床医生在诊断中使用他们的因果理论。特别是，Ahn等人（2006）发现，临床医生只将一些DSM精神障碍视为自然界发现的类型；其他的则被认为是文化上的发明。这一提议验证了一个假设，即临床医生越相信精神障碍是自然类型，他们就越会在分类中使用他们的因果理论。这些研究将利用临床医生对精神障碍的分类来阐明因果知识影响分类的一般认知机制。其次，下一版DSM的一个突出建议是消除人格障碍的类别，只使用潜在的特征。现有的概念和专业知识认知理论预测，消除分类和强加给临床医生基于特征的推理将破坏患者的沟通、记忆和推断。然而，如果临床医生认为当前的分类法不完整或无效，则维度系统可能具有很大的临床效用。拟议的研究提供了必要的深入测试的临床效用的维度系统，这可以告知决定他们的采用。总之，该提案描述了转化研究：认知科学中发展的基本理论和方法将被应用于理解当前的临床实践以及当前和拟议的精神障碍分类的临床应用。与公共健康相关：许多美国人患有精神障碍，并向精神健康从业者寻求治疗。然而，临床医生对精神障碍的概念知之甚少，目前对精神障碍的分类也存在争议。拟议的研究将有助于理解和改进临床实践，并及时为2011年出版的下一版DSM开发心理上直观的精神障碍分类。

DESCRIPTION (provided by applicant): Project Summary: This proposal aims to understand mental health professionals' concepts of mental disorders in light of (1) the current DSM and (2) a proposal for its revision. First, the DSM-IV purposely does not specify the causes of mental disorders because they are still controversial. Previous studies supported by NIMH, however, found that clinicians have rich causal theories about mental disorders and these theories determine which symptoms matter more in diagnoses. The proposed studies build on these studies and will further examine what moderates clinicians' use of their causal theories in diagnoses. In particular, Ahn, et al. (2006) found that clinicians only view some DSM mental disorders as kinds discovered in nature; others were thought of as culturally invented kinds. This proposal tests the hypothesis that the more clinicians believe that mental disorders are natural kinds, the more they will use their causal theories in categorization. These studies will use clinicians' categorization of mental disorders to illuminate a general cognitive mechanism by which causal knowledge influences categorization. Second, one prominent proposal for the next version of the DSM is to eliminate categories of personality disorders and to use only underlying traits. Existing cognitive theories of concepts and expertise predict that eliminating categories and imposing trait-based reasoning on clinicians would disrupt communicability of, memory for, and inferences about patients. However, dimensional systems might have great clinical utility if clinicians feel that the current taxonomy is incomplete or invalid. The proposed studies provide necessary in-depth tests of the clinical utility of the dimensional systems, which can inform decisions about their adoption. In sum, the proposal describes translational research: basic theories and methods developed in cognitive science are to be applied to understanding current clinical practices and the clinical utility of current and proposed taxonomy of mental disorders. Relevance to Public Health: Many Americans suffer from mental disorders and seek therapies from mental health practitioners. Yet clinicians' concepts of mental disorders are poorly understood, and the current taxonomy of mental disorders is controversial. The proposed studies will aid in understanding and improving clinical practices and in developing psychologically intuitive taxonomies of mental disorders in time for the next version of the DSM due in 2011.